Provider Demographics
NPI:1982982245
Name:PADILLA, RAMON R (PT)
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:R
Last Name:PADILLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 CAJA DEL ORO GRANT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3287
Mailing Address - Country:US
Mailing Address - Phone:505-660-6039
Mailing Address - Fax:505-473-5895
Practice Address - Street 1:2361 CAJA DEL ORO GRANT RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3287
Practice Address - Country:US
Practice Address - Phone:505-660-6039
Practice Address - Fax:505-473-5895
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM09341174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator